Complex Care Manager

Description and Requirements

This position is 100% Remote The 'Complex Care' DM Care Manager takes a holistic (medical, behavioral, psychosocial) approach to planning and managing the care of High Risk Diabetic members. The Care Manager works with members, caregivers and/or providers to ensure appropriate access to care, adherence to treatment plans and improvement in outcomes. The Care Manager is responsible for applying care management when engaging members and addressing coordination of the member's health care services. The Care Manager will oversee a panel of members for whom he/she is the primary case owner. The Care Manager will be responsible for tracking their assigned panel of members and intervening as needed to close care gaps, reducing avoidable hospitalizations or ER visits, addressing social risk factors, and reducing health inequities.

Duties/Responsibilities:

• Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
• Conducts assessments to identify barriers and opportunities for intervention.
• Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals.
• Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
• Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly.
• Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes.
• Assists in identifying opportunities for alternative care options based on member needs and assessments.
• Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan.
• Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
• Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
• Occasional overtime as necessary.
• Additional duties as assigned.